Therapy Services: Procedural Requirements

The Department will pay for therapy services rendered by a therapy professional if such services are ordered by a provider as part of a plan of care. (7-1-26) 01. Orders. (7-1-26) a. Services must be reordered at least every ninety (90) days or for individuals with long-term medical conditions, as documented by a provider, at least every three hundred sixty-five (365) days. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 255 Page 73 b. Therapy services provided under home health must comply with the order requirements in home health instead. (7-1-26) 02. Therapy Plan of Care. All therapy services must be provided under a therapy plan of care that is based on an evaluation and is established prior to beginning treatment. (7-1-26) a. The plan of care must be signed by the person who established the plan and sent to the ordering provider within thirty (30) days of the evaluation to continue therapy services. (7-1-26) b. The plan of care must be consistent with the therapy evaluation and contain: (7-1-26) i. Diagnoses; (7-1-26) ii. Treatment goals that are measurable and pertain to the identified functional impairment(s); and (7-1-26) iii. Type, frequency, and duration of therapy services. (7-1-26) c. Therapy services provided under home health must comply with the home health plan of care requirements. (7-1-26) 254. (RESERVED)